2070 Mitral valve prolapse is associated with abnormal CMR late gadolinium enhancement of the mitral valve leaflets and the papillary muscles
© Han et al; licensee BioMed Central Ltd. 2008
Published: 22 October 2008
Perivalvular ventricular and papillary muscle fibrosis has been well described in pathologic studies of mitral valve prolapse (MVP) patients, but has not been reported by non-invasive imaging. We applied 2D and high resolution 3D late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) in 14 MVP patients with myxomatous mitral leaflets and 4 control patients.
CMR was performed using a commercial Philips 1.5 T MR whole body scanner (Intera Achieva, Philips Medical Systems, Best, Netherlands) equipped with a 5-element cardiac synergy coil. 15 minutes following IV administration of 0.2 mmol/kg gadolinium-DTPA, 2D LGE-CMR was performed in the short axis and long axis orientation as previously described. Scan parameters: TR 4.3 ms, TE 2.1 ms, flip angle 15°, FOV 320 mm, matrix 160 × 160, spatial resolution 2 × 2 × 8 mm3 reconstructed to 1.2 × 1.2 × 8 mm3 using zero-padding. At 20 minutes post injection, a ECG-gated free breathing, respiratory navigator gated 3D LGE-MRI scan were obtained during free-breathing as previously described. TR 4.3 ms, TE 2.1 ms, flip angle 15°, FOV: 320 mm, full echo, matrix 224 × 224 × 23–32 partition-encoded lines, spatial resolution 1.3 × 1.3 × 5 mm3 reconstructed to 0.6 × 0.6 × 2.5 mm3. For both 2D and 3D LGE-MRI scans, fat saturation was applied and inversion times were determined using the Look-Locker sequence. Arrhythmia monitoring by a Holter or an event monitor in the last five years were available in 11 patients. Complex ventricular arrhythmia (CVA) is defined by the presence of monomorphic couplets or non-sustained ventricular tachycardia. Absence of CVA was determined by a negative Holter or event monitor, or no symptoms and no records of CVA in the last five years.
In the MVP population, LGE of papillary muscles identified by higher resolution 3D LGE-CMR methods is associated with complex ventricular arrhythmia. Extensive LGE of the mitral leaflets is present in the majority of patients with myxomatous mitral valves.
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